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WHOLE HEALTH: INFORMATION FOR VETERANSAn Introduction to Mindful AwarenessWhole Health is an approach to health care that empowers and enables YOU to takecharge of your health and well-being and live your life to the fullest. It starts with YOU. Itis fueled by the power of knowing yourself and what will really work for you in your life.Once you have some ideas about this, your team can help you with the skills, support,and follow up you need to reach your goals.All resources provided in these handouts are reviewed by VHA clinicians and Veterans.No endorsement of any specific products is intended. Best wishes!https://www.va.gov/wholehealth/

An Introduction to Mindful AwarenessAn Introduction to Mindful AwarenessWhat is mindful awareness?Mindful awareness is paying attention in a particular way: on purpose, in the presentmoment, and nonjudgmentally.1Did you ever drive or walk somewhere and later not remember seeing anything along theway? Or did you eat a meal and, before you knew it, your food was gone without reallyenjoying it? It is easy to go through daily life on autopilot. Perhaps you were mulling oversomething that has happened in the past. Or maybe you were anticipating or worryingabout something that will happen in the future. But what about the present? Are you attimes so caught up in the past or future that you are not fully experiencing the present? Ifso, you are like most people. It is possible to learn a different way to relate to the world,with greater awareness. Mindful awareness can do a lot to help us live healthier, fullerlives.Why is mindful awareness important?Mindful awareness is at the heart of Whole Health. You can see this depicted in the Circleof Health below. Mindful awareness helps you to be aware of thoughts and feelings. Yetyou don’t focus on them. Instead, mindful awareness helps you focus on the present andwhat is most important to you.Page 2 of 8

An Introduction to Mindful AwarenessHow can I better understand what mindful awareness is?You can try the following exercise to get a better sense of mindful awareness.Breath Awareness PracticeSit comfortably with your feet planted firmly on the floor. Explore lengthening yourspine, allowing it to stretch out like a string of pearls. Now, for the next two minutes, youare invited to turn all of your awareness to your breathing. Do not change how youbreathe. Just pay attention to how it feels to breathe in and breathe out and to the pausesbetween your breaths.How easy was it to focus your attention on your breathing for two straight minutes?Consider taking two additional minutes to repeat the exercise. This time, when yourthoughts wander away from your breath, gently return your attention to yourbreathing. If a judgment arises, simply notice that this is a thought. Then bring yourattention back to your breathing. When your mind wanders, be gentle withyourself. All of our minds wander. That’s what minds do. It’s OK. When you noticeyour mind wandering, simply bring your attention back to your breath.You have now practiced mindful awareness. Do not be concerned if you had troublecompleting the exercise above without distractions or judgments. Mindful awarenessgrows with practice. Over time and with practice, it can become easier and more natural.How can I learn to be more mindful?You can practice mindful awareness on your own as you go about your daily life. Or youcan take a class. Taking a class provides several benefits. You commit time to practice. Ateacher is available to answer questions that come up as you practice. And you hear whatworks for others. Veterans may find it meaningful to share experiences with otherVeterans in a class setting. Two well-known classes are mindfulness-based stressreduction (MBSR) and mindfulness-based cognitive therapy (MBCT). Mindfulness-based stress reduction (MBSR). Jon Kabat-Zinn, PhD, developedMBSR in 1979. His goal was to help patients with stress, chronic pain, and illness.MBSR trains people in mindfulness meditation. It helps them use it for thechallenges and adventures of everyday life.2 MBSR is an eight-week program—atotal of 31 hours. MBSR includes meditation, mindful movement, group discussion,and practice at home.Mindfulness-based cognitive therapy (MBCT). MBCT is an eight-week classdesigned to prevent relapse in people who have recovered from depression.3 Itinvolves 31 hours of training. MBCT can show you how your mood and the way youthink may help cause depression and trigger relapse. In MBCT you learn torecognize early signs of relapse. You can then turn away from negative moods andthoughts before they become severe.Page 3 of 8

An Introduction to Mindful AwarenessMany VA medical centers offer mindfulness training. Contact the VA medical center in yourarea to learn about available classes. Whether you practice mindful awareness on yourown or take a class, you may be interested in audio files to help you practice. See theresources at the end of this document for audio files available from the VA.I am an older Veteran. I wonder if I am too old to learn mindful awareness?Mindful awareness can be helpful to people of any age. Overall, older adults have beenfound to be more mindful than younger adults.4 So, practicing mindful awareness may bemore natural for them.5 In the past few years, some studies have especially focused onMBSR and MBCT for older adults. A review of 15 studies found that most older adults likedthe classes and found them helpful.5 The classes especially helped with anxiety,depression, stress, and dealing with pain.Are there any concerns I should know about if I want to practice mindfulawareness?In general, mindful awareness is a safe practice. As with any new practice, some peoplemay initially feel uncomfortable. For most people the benefits far outweigh any harm.Some people feel a bit of emotional distress when first starting mindful awareness practice.This can occur as you become more aware of your behaviors, emotions, and thoughts. Ifyou have a mental health challenge such as strong anxiety, a psychotic disorder, or severeposttraumatic stress disorder (PTSD), it is important to practice under the guidance of aprofessional.In general, what are the benefits of mindful awareness?Mindful awareness can help you live your life more fully, with all its joys and challenges. Ingeneral, mindful awareness may Improve the quality of your life by helping you experience more moments of yourlife Help you see things as they really are, by observing—but not judging—yourexperiences.What other studies have been done?Studies are being done to learn how helpful mindful awareness is for specific conditions.Many study results are promising. Mindfulness meditation is the form of mindfulawareness that is studied most often. Research continues. Some important findings arelisted below.Physical Body Mindfulness meditation led to longer periods of relaxation.6 Meditation increased activity in the part of the brain linked to positive mood.7Immune System Mindfulness training strengthened the body’s immune system. (These are parts thatprotect the body and fight disease).8-10Page 4 of 8

An Introduction to Mindful AwarenessMental Health Mindfulness training reduced mental health symptoms in people with a number ofdifferent chronic diseases.11-13 Mindfulness training decreased symptoms for patients with depression andanxiety.14-16 MBCT helped to prevent relapse in people who had major depression.8,17-19 In onestudy, MBCT helped 75% of people with a history of major depression to get off andremain off their medication.19 Findings were mixed for PTSD. In one study, the PTSD symptoms of combatVeterans improved following MBCT.20 MBSR did not reduce PTSD symptoms insome studies, but did in others.21,22 One of these studies found that MBSR helpedVeterans with PTSD function better.22 Also, their depression symptoms decreased.However, MBSR did not reduce other symptoms of PTSD.22Chronic Pain Findings were mixed for chronic back pain. Some studies showed improvementfollowing MBSR and others did not.23 One study found that MBSR decreased painintensity, disability, and medication use.23 It improved sleep. Again, research found mixed results for patients with fibromyalgia.24,25 One studyfound large improvement in many fibromyalgia symptoms following MBSR.24Other Findings Mindful awareness assists with the treatment of alcohol and substance misuse.26 MBSR reduced irritable bowel symptoms in a study of Veterans.27For you to consider: Do you want to explore mindful awareness further? Is this something you want towork on?Is there anything in particular that grabs your attention in this handout?Are you interested in taking a MBSR class?Have you had clinical depression? If so, are you interested in learning more aboutMBCT?For some ways to practice mindful awareness on your own, see the Whole Healthhandout “Mindful Awareness Practice in Daily Living.”The information in this handout is general. Please work with your health care team touse the information in the best way possible to promote your health and happiness.Page 5 of 8

For more information:ORGANIZATIONVeterans HealthAdministrationVA "Whole Health”websiteVA "Whole Health”website“Circle of Health”An Introduction to Mindful AwarenessRESOURCESA variety of WholeHealth handouts onmindful awarenessMindfulness:Embracing theMoment (Describesone Veteran’sexperience withmindfulness) Instructional videoson mindfulness Audio files andpodcasts on guidedmeditationIn this video, VeteranVA “The War RelatedPatrick CrehanIllness & Injury Studydiscusses benefits ofCenter's STAR WellmindfulnessKit” websitemeditation.VA websiteVA “Health ServicesResearch &Development”websiteMindfulness CoachApp (Designed to helpVeterans, Servicemembers, and otherslearn to practicemindfulness.)Evidence Map ofMindfulness(Written at a level LEHEALTH/features/Mindfulness Embracing the -health/mindfulawareness.asp Click on “Video Resources” Click on “Guided Meditation AudioFiles”https://www.youtube.com/watch?v ufbdtF5jbBs&index 8&list PL3AQ v/publications/esp/cam mindfulnessREPORT.pdfThis handout was written for the Veterans Health Administration (VHA) by Charlene LuchterhandMSSW, Education and Research Coordinator, Integrative Health Program, University of WisconsinDepartment of Family Medicine and Community Health. It is based in part on an overview forclinicians, Mindful Awareness, written by Adrienne Hampton, MD. The handout was reviewed andedited by Veterans and VHA subject matter experts.Page 6 of 8